scholarly journals Acute Kidney Disease and Mortality in Acute Kidney Injury Patients with COVID-19

2021 ◽  
Vol 10 (19) ◽  
pp. 4599
Author(s):  
Filipe Marques ◽  
Joana Gameiro ◽  
João Oliveira ◽  
José Agapito Fonseca ◽  
Inês Duarte ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Significant Risk ◽  
Kidney Injury ◽  
Risk Of Mortality ◽  
Number Of Patients ◽  
Acute Kidney Disease ◽  
Risk Patients ◽  
Stage 1

Background: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients is variable and has been associated with worse prognosis. A significant number of patients develop persistent kidney damage defined as Acute Kidney Disease (AKD). There is a lack of evidence on the real impact of AKD on COVID-19 patients. We aim to identify risk factors for the development of AKD and its impact on mortality in COVID-19 patients. Methods: Retrospective analysis of COVID-19 patients with AKI admitted at the Centro Hospitalar Universitário Lisboa Norte between March and August of 2020. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. AKD was defined by presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. Results: In 339 COVID-19 patients with AKI, 25.7% patients developed AKD (n = 87). The mean age was 71.7 ± 17.0 years, baseline SCr was 1.03 ± 0.44 mg/dL, and the majority of patients were classified as KDIGO stage 3 AKI (54.3%). The in-hospital mortality was 18.0% (n = 61). Presence of hypertension (p = 0.006), CKD (p < 0.001), lower hemoglobin (p = 0.034) and lower CRP (p = 0.004) at the hospital admission and nephrotoxin exposure (p < 0.001) were independent risk factors for the development of AKD. Older age (p = 0.003), higher serum ferritin at admission (p = 0.008) and development of AKD (p = 0.029) were independent predictors of in-hospital mortality in COVID-19-AKI patients. Conclusions: AKD was significantly associated with in-hospital mortality in this population of COVID-19-AKI patients. Considering the significant risk of mortality in AKI patients, it is of paramount importance to identify the subset of higher risk patients.

Renal Outcomes of Dialysis-Dependent Acute Kidney Injury in Noncritically Ill Patients: A Retrospective Study

2021 ◽  
pp. 1-7
Author(s):  
Pasquale Esposito ◽  
Alessandro Avella ◽  
Fiorenza Ferrari ◽  
Giancarlo Bruno ◽  
Carmelo Libetta ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
Kidney Disease ◽  
Significant Risk ◽  
Kidney Injury ◽  
Renal Recovery ◽  
Renal Outcomes ◽  
Acute Kidney Disease ◽  
Stage 1 ◽  
Clinical Conditions

<b><i>Introduction:</i></b> Acute kidney injury (AKI) is a common complication among hospitalized patients, potentially affecting short- and long-term clinical outcomes. In this retrospective study, we evaluated renal outcomes in noncritically ill patients who required acute hemodialysis (HD) because of an AKI episode occurring during hospitalization. <b><i>Methods:</i></b> Sixty-three hemodynamically stable patients with AKI undergoing acute intermittent HD were included. Kidney function was evaluated at baseline control (pre-AKI), at AKI diagnosis and during the follow-up. According to serum creatinine and the estimated glomerular filtration rate (eGFR), we defined three clinical conditions: renal recovery, different stages of acute kidney disease (AKD), and chronic kidney disease (CKD). <b><i>Results:</i></b> Among the 63 patients evaluated, 34 patients (54%) had a history of CKD. Six patients (10%) presented early full renal recovery. HD treatment was stopped in 38 patients (60%), while 25 patients (40%) required maintenance HD. Dialysis-independent patients presented lower comorbidity and higher baseline eGFR and delta creatinine, compared to dialysis-dependent patients. Baseline CKD, previous AKI episodes, and parenchymal causes of AKI were associated with a significant risk of dialysis dependence. At 1-month control, 15 patients (39%) presented AKD stage 0, 6 patients (16%) AKD stage 1, and 17 patients (44%) AKD stage 2–3. At 3-month control, 29 out of 38 patients recovering from AKI (76%) presented CKD. AKD stage was significantly correlated with the risk of CKD development, which, resulted higher in patients with lower baseline eGFR. <b><i>Conclusions:</i></b> AKI might represent a risk factor for the development of chronic kidney damage, even in noncritically ill patients.

MO348CLINICAL TRAJECTORIES AND IMPACT OF ACUTE KIDNEY DISEASE AFTER ACUTE KIDNEY INJURY IN INTENSIVE CARE UNIT: A 5-YEAR SINGLE-CENTER COHORT STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Arthur Orieux ◽  
Mathilde Prezelin-Reydit ◽  
Christian Combe ◽  
Renaud Prevel ◽  
Alexandre Boyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Proportional Hazard ◽  
Acute Kidney Disease ◽  
Incidence Of Ckd ◽  
Stage 1

Abstract Background and Aims Acute kidney injury (AKI) is observed in more than 50% of patients admitted in intensive care units (ICU) and more than 10% of them require renal replacement therapy (RRT) Acute kidney disease (AKD) has been recently proposed to describe a highly vulnerable period with pathophysiological process following AKI during which the patient could experience a decline in glomerular filtration and finally developed CKD. Patients suffering from AKI in ICU could have various renal trajectories and outcomes (early, late, or absence of recovery; early or late relapse; acute kidney disease (AKD); or chronic kidney disease (CKD)) after discharge. No cohort study described them accurately. Aims were to assess the various clinical trajectories after AKI in ICU and to determine risk factors for developing CKD taking into account the new concept of AKD and to assess the long-term incidence of CKD. Method We conducted a prospective five-year follow-up study in a medical ICU in Bordeaux University Hospital (France). The patients who received invasive mechanical ventilation, catecholamine infusion or both and developed an AKI (defined by KDIGO criteria) from September 2013 to May 2015 were included. We excluded the patients with a previous estimated glomerular filtration rate (eGFR) of &lt;90mL/min/1.73m2. AKD was defined as a condition wherein the criteria for AKI stage 1 or greater persists ≥7 days after exposure. CKD was defined by an eGFR of &lt;60ml/min/1.73m2 at least 90 days after the AKI. Renal recovery was defined by serum creatinine ≤125% of serum basal creatinine. Using the Aalen-Johansen estimator to account for competing risks, we estimated the cumulative incidence of CKD. To estimate adjusted hazard ratios (HRs) we used standard Cox proportional hazard models adjusted for age, sex, hypertension, diabetes, cardiovascular history, SOFA and AKI stage. Proportional hazard assumptions were checked using Schoenfeld residuals. Violation of proportional hazard assumption for AKD was handled by using appropriate interaction terms with time, resulting in time-dependent HR. Results 232 patients were enrolled. The age was 62 ± 16 years, 142/232 (61%) were male. AKI stage 1 was present in 62/232 (27%) patients, AKI stage 2 in 50/232 (21%), and AKI stage 3 in 120/232 (52%). Among patients with AKI, 65/232 (28%) recovered before day 7. At day 7, 106/232 (46%) had been progressing to AKD. AKD also developed secondary in 3/65 because of a second episode of AKI without recovery. Among the AKD patients, 21/109 (19%) recovered before day 90, 41/109 (38%) dead and 47/109 (43%) progressed to CKD (figure). The cumulative incidence of CKD was 17 [12-21]% at 1-year follow-up and 30 [24-36] % at 5-years follow-up. This incidence was higher in AKD-patients (44 [35-54]%, and 48 [39-58]%) than in non-AKD patients (9 [1-16]% and 22 [10-34]%) after 1 and 5 years of follow-up, respectively (p=6.10-5). The risk of developing CKD in AKD-patients was increased up to six months compared to those without AKD (HR 27.1 [7.9-93.5]; p&lt;0.0001). Six months after AKI, the risk of progression to CKD was not statistically different between AKD patients and non-AKD patients (HR 2.45 [0.68 – 8.85]; p = 0.17). In this model only gender (male sex: HR 0.5 [0.3-0.9]; p= 0.02) was also significantly associated with CKD. Conclusion There were many clinical trajectories after AKI in ICU. Risk for developing CKD remained during the 5 years of follow-up. AKD was the main risk factors for developing CKD only in the first 6 months. After, the risk was similar in AKD or non-AKD patients. Female gender was associated with CKD during all the follow-up. These patients need a specific follow-up after ICU discharge.

scholarly journals Risk factors for acute kidney injury among patients with chikungunya: a multi-center experience from the 2017 chikungunya outbreak in Dhaka, Bangladesh

2019 ◽  
Vol 9 (3) ◽  
pp. 193-196
Author(s):  
Shahana Zaman ◽  
Muhammad Abdur Rahim ◽  
Mehruba Alam Ananna ◽  
Ishrat Jahan ◽  
Tufayel Ahmed Chowdhury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Angiotensin Receptor Blockers ◽  
Significant Risk ◽  
Kidney Injury ◽  
Febrile Illness ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Adult Patients ◽  
Converting Enzyme Inhibitors

Background: Chikungunya is an emerging viral infection in Bangladesh. This self-limiting febrile illness may have acute life-threating features including cardiomyopathy and encephalitis. Acute kidney injury (AKI) is less well described complication of chikungunya. This study was designed to evaluate risk factors for AKI among patients with chikungunya virus infection. Methods: This case-control study was done in 3 different centers in Dhaka, Bangladesh from July to October 2017. Adult patients (>18 years) with confirmed diagnosis of chikungunya were included in this study. AKI was diagnosed as per Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury. Patients suffering from chikungunya complicated by AKI were cases and those without AKI were controls. Results: Total patients were 107 (male 61) with a mean age of 35.6 (range 19-84) years. Common comorbidities were diabetes mellitus (DM) (20.6%), hypertension (17.8%) and chronic kidney disease (CKD) (12.1%). Common presentations included fever (86.9%) or recent history of fever (13.1%), joint pain (88.8%), rash (23.4%), pruritus (15.9%), gastro-intestinal (GI) features like diarrhea and/or vomiting (28%), lymphadenopathy (12.1%), gum swelling/oral ulcer (4.1%) and oedema (8.4%). Fourteen (13.1%) patients required hospitalization. Eleven (10.3%) cases were complicated by AKI. Among the risk factors for AKI, comorbidities like DM (OR 28.73, 95% CI 5.57-148.10, p 0.0001) and CKD (OR 31.0, 95% CI 2.94-326.7, p <0.0001), GI features (OR 16.07, 95% CI 3.22-80.14, p 0.0007), requirement of hospitalization (OR 23.10, 95% CI 2.37-226.31, p <0.0001) and use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) (OR 6.65, 95% CI 1.77-24.98, p 0.005) were significant. Conclusions: One-tenth of adult patients suffering from chikungunya were complicated by AKI in this study. DM, CKD, diarrhea and/or vomiting, hospitalization and use of ACEIs/ARBs appeared as significant risk factors for AKI. Birdem Med J 2019; 9(3): 193-196

scholarly journals Acute kidney injury in hospitalized patients with COVID-19

2020 ◽  
Author(s):  
Joana Gameiro ◽  
José Agapito Fonseca ◽  
João Oliveira ◽  
Filipe Marques ◽  
João Bernardo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Multivariate Analysis ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Single Center ◽  
Transient Aki ◽  
Worse Prognosis

Abstract Introduction: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients ranges from 0.5 to 35% and has been associated with worse prognosis. The purpose of this study was to evaluate the incidence, severity, duration, risk factors and prognosis of AKI in hospitalized patients with COVID-19.Methods: We conducted a retrospective single-center analysis of 192 hospitalized COVID-19 patients from March to May of 2020. AKI was diagnosed using the Kidney Disease Improving Global Outcome (KDIGO) classification based on serum creatinine (SCr) criteria. Persistent and Transient AKI were defined according to the Acute Disease Quality Initiative (ADQI) workgroup definitions.Results: In this cohort of COVID-19 patients, 55.2% developed AKI (n=106). The majority of AKI patients had persistent AKI (n=64, 60.4%). Overall, in-hospital mortality was 18.2% (n=35) and was higher in AKI patients (28.3% vs 5.9%, p<0.001, unadjusted OR 6.03 (2.22-16.37), p<0.001). On a multivariate analysis, older age (adjusted OR 1.08 (95% CI 1.02-1.13), p=0.004), lower Hb level (adjusted OR 0.69 (95% CI 0.53-0.91), p=0.007) and acidemia at presentation (adjusted OR 5.53 (95% CI 1.70-18.63), p=0.005), duration of AKI (adjusted OR 7.91 for persistent AKI (95% CI 2.39-26.21), p=0.001) and severity of AKI (adjusted OR 2.30 per increase in KDIGO stage (95% CI 1.10-4.82), p=0.027) were independent predictors of mortality.Conclusion: AKI was frequent in hospitalized patients with COVID-19. Persistent AKI and higher severity of AKI were independent predictors of in-hospital mortality.

Acute Kidney Injury in Critically Ill Children: A Retrospective Analysis of Risk Factors

2019 ◽  
Vol 49 (1-2) ◽  
pp. 1-7 ◽  
Author(s):  
Francesca De Zan ◽  
Angela Amigoni ◽  
Roberta Pozzato ◽  
Andrea Pettenazzo ◽  
Luisa Murer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Significant Risk ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Critically Ill Children ◽  
Multiple Organ Dysfunction ◽  
Risk Of Mortality ◽  
Nephrotoxic Drugs

Introduction: Children admitted to paediatric intensive care unit (PICU) are at risk of acute kidney injury (AKI). However, few paediatric studies have focused on the identification of factors potentially associated with the development of this condition. The aim of our study was to assess the incidence rate of AKI, identify risk factors, and evaluate clinical outcome in a large sample of critically ill children. Methods: This retrospective observational study was conducted including patients admitted to our PICU from January 2014 to December 2016. AKI was defined according to Kidney Disease: Improving Global Outcome criteria. Results: A total of 222 PICU patients out of 811 (27%) had AKI (stage I 39%, stage II 24%, stage III 37%). The most common PICU admission diagnoses in AKI cases were heart disease (38.6%), respiratory failure (16.8%) and postsurgical non-cardiac patients (11%). Hypoxic-ischaemic was the most frequent cause of AKI. Significant risk factors for AKI following multivariate analysis were age >2 months (OR 2.43; 95% CI 1.03–7.87; p = 0.05), serum creatinine at admission >44 µmol/L (OR 2.23; 95% CI 1.26–3.94; p = 0.006), presence of comorbidities (OR 1.84; 95% CI 1.03–3.30; p = 0.04), use of inotropes (OR 2.56; 95% CI 1.23–5.35; p= 0.012) and diuretics (OR 2.78; 95% CI 1.49–5.19; p = 0.001), exposure to nephrotoxic drugs (OR 1.66; 95% CI 1.01–2.91; p= 0.04), multiple organ dysfunction syndrome (OR 2.68; 95% CI 1.43–5.01; p = 0.002), and coagulopathy (OR 1.89; 95% CI 1.05–3.38, p = 0.03). AKI was associated with a significant longer PICU stay (median LOS of 8 days, interquartile range [IQR] 3–16, versus 4 days, IQR 2–8, in non-AKI patients; p < 0.001). The mortality rate resulted tenfold higher in AKI than non-AKI patients (12.6 vs. 1.2%; p < 0.001). Conclusions: The incidence of AKI in critically ill children is high, with an associated increased length of stay and risk of mortality. In the PICU setting, risk factors of AKI are multiple and mainly associated with illness severity.

scholarly journals Risk Factors and Outcomes of Acute Kidney Injury in Critically Ill Patients with Coronavirus Disease 2019

2020 ◽  
pp. 1-9
Author(s):  
Yichun Cheng ◽  
Nanhui Zhang ◽  
Ran Luo ◽  
Meng Zhang ◽  
Zhixiang Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Stage 1

<b><i>Background:</i></b> Coronavirus disease 2019 (COVID-19) has emerged as a major global health threat with a great number of deaths worldwide. Acute kidney injury (AKI) is a common complication in patients admitted to the intensive care unit. We aimed to assess the incidence, risk factors and in-hospital outcomes of AKI in COVID-19 patients admitted to the intensive care unit. <b><i>Methods:</i></b> We conducted a retrospective observational study in the intensive care unit of Tongji Hospital, which was assigned responsibility for the treatments of severe COVID-19 patients by the Wuhan government. AKI was defined and staged based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Mild AKI was defined as stage 1, and severe AKI was defined as stage 2 or stage 3. Logistic regression analysis was used to evaluate AKI risk factors, and Cox proportional hazards model was used to assess the association between AKI and in-hospital mortality. <b><i>Results:</i></b> A total of 119 patients with COVID-19 were included in our study. The median patient age was 70 years (interquartile range, 59–77) and 61.3% were male. Fifty-one (42.8%) patients developed AKI during hospitalization, corresponding to 14.3% in stage 1, 28.6% in stage 2 and 18.5% in stage 3, respectively. Compared to patients without AKI, patients with AKI had a higher proportion of mechanical ventilation mortality and higher in-hospital mortality. A total of 97.1% of patients with severe AKI received mechanical ventilation and in-hospital mortality was up to 79.4%. Severe AKI was independently associated with high in-hospital mortality (OR: 1.82; 95% CI: 1.06–3.13). Logistic regression analysis demonstrated that high serum interleukin-8 (OR: 4.21; 95% CI: 1.23–14.38), interleukin-10 (OR: 3.32; 95% CI: 1.04–10.59) and interleukin-2 receptor (OR: 4.50; 95% CI: 0.73–6.78) were risk factors for severe AKI development. <b><i>Conclusions:</i></b> Severe AKI was associated with high in-hospital mortality, and inflammatory response may play a role in AKI development in critically ill patients with COVID-19.

scholarly journals Acute kidney disease in hospitalized acute kidney injury patients

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11400
Author(s):  
Ping Yan ◽  
Xiang-Jie Duan ◽  
Yu Liu ◽  
Xi Wu ◽  
Ning-Ya Zhang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Critically Ill ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Additional Information ◽  
Acute Kidney Disease ◽  
Tertiary Hospitals ◽  
One Year ◽  
Stage 1

Background Acute kidney injury (AKI) and chronic kidney disease (CKD) have become worldwide public health problems, but little information is known about the epidemiology of acute kidney disease (AKD)—a state in between AKI and CKD. We aimed to explore the incidence and outcomes of hospitalized patients with AKD after AKI, and investigate the prognostic value of AKD in predicting 30-day and one-year adverse outcomes. Methods A total of 2,556 hospitalized AKI patients were identified from three tertiary hospitals in China in 2015 and followed up for one year.AKD and AKD stage were defined according to the consensus report of the Acute Disease Quality Initiative 16 workgroup. Multivariable regression analyses adjusted for confounding variables were used to examine the association of AKD with adverse outcomes. Results AKD occurred in 45.4% (1161/2556) of all AKI patients, 14.5% (141/971) of AKI stage 1 patients, 44.6% (308/691) of AKI stage 2 patients and 79.6% (712/894) of AKI stage 3 patients. AKD stage 1 conferred a greater risk of Major Adverse Kidney Events within 30 days (MAKE30) (odds ratio [OR], 2.36; 95% confidence interval 95% CI [1.66–3.36]) than AKD stage 0 but the association only maintained in AKI stage 3 when patients were stratified by AKI stage. However, compared with AKD stage 0, AKD stage 2–3 was associated with higher risks of both MAKE30 and one-year chronic dialysis and mortality independent of the effects of AKI stage with OR being 31.35 (95% CI [23.42–41.98]) and 2.68 (95% CI [2.07–3.48]) respectively. The association between AKD stage and adverse outcomes in 30 days and one year was not significantly changed in critically ill and non-critically ill AKI patients. The results indicated that AKD is common among hospitalized AKI patients. AKD stage 2–3 provides additional information in predicting 30-day and one-year adverse outcomes over AKI stage. Enhanced follow-up of renal function of these patients may be warranted.

scholarly journals Severe postoperative hyperbilirubinemia in congenital heart disease

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 1276-1285
Author(s):  
Xiaolan Chen ◽  
Ming Bai ◽  
Shiren Sun ◽  
Xiangmei Chen
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Hospital Mortality ◽  
Congenital Heart ◽  
Kidney Injury ◽  
Term Survival ◽  
Risk Of Mortality ◽  
Long Term Mortality

Abstract Purpose The purpose of our present study was to explore the characteristics and outcomes of congenital heart disease (CHD) patients with severe postoperative hyperbilirubinemia. Methods All patients who underwent cardiopulmonary bypass surgical treatment for CHD and had severe postoperative hyperbilirubinemia (total bilirubin [TB] ≥85.5 μmol/L) in our center between January 2015 and December 2018 were retrospectively screened. Univariate and multivariate analyses were employed to identify risk factors for the study endpoints, including postoperative acute kidney injury (AKI), in-hospital mortality, and long-term mortality. Results After screening, 86 patients were included in our present study. In-hospital mortality was 10.9%. Fifty-one (59.3%) patients experienced AKI, and four (4.7%) patients received continuous renal replacement therapy. Multivariate analysis identified that the peak TB concentration (P = 0.002) and duration of mechanical ventilation (P = 0.008) were independent risk factors for in-hospital mortality, and stage 3 AKI was an independent risk factor for long-term mortality. The optimal cutoff value for peak TB concentration was 125.9 μmol/L. Patients with a postoperative TB level ≥125.9 μmol/L had worse long-term survival. Conclusion Hyperbilirubinemia was a common complication after CHD surgery. CHD patients with severe postoperative hyperbilirubinemia ≥125.9 μmol/L and AKI had a higher risk of mortality.

scholarly journals Novel risk models to predict acute kidney disease and its outcomes in a Chinese hospitalized population with acute kidney injury

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ye-Qing Xiao ◽  
Wei Cheng ◽  
Xi Wu ◽  
Ping Yan ◽  
Li-Xin Feng ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Respiratory Failure ◽  
High Risk ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Scoring Model ◽  
High Risk Patients ◽  
Acute Kidney Injury Stage ◽  
Acute Kidney Disease ◽  
Risk Patients

Abstract Acute kidney disease (AKD) is a state between acute kidney injury (AKI) and chronic kidney disease (CKD), but the prognosis of AKD is unclear and there are no risk-prediction tools to identify high-risk patients. 2,556 AKI patients were selected from 277,898 inpatients of three affiliated hospitals of Central South University from January 2015 to December 2015. The primary point was whether AKI patients developed AKD. The endpoint was death or end stage renal disease (ESRD) 90 days after AKI diagnosis. Multivariable Cox regression was used for 90-day mortality and two prediction models were established by using multivariable logistic regression. Our study found that the incidence of AKD was 53.17% (1,359/2,556), while the mortality rate and incidence of ESRD in AKD cohort was 19.13% (260/1,359) and 3.02% (41/1,359), respectively. Furthermore, adjusted hazard ratio of mortality for AKD versus no AKD was 1.980 (95% CI 1.427–2.747). In scoring model 1, age, gender, hepatorenal syndromes, organic kidney diseases, oliguria or anuria, respiratory failure, blood urea nitrogen (BUN) and acute kidney injury stage were independently associated with AKI progression into AKD. In addition, oliguria or anuria, respiratory failure, shock, central nervous system failure, malignancy, RDW-CV ≥ 13.7% were independent risk factors for death or ESRD in AKD patients in scoring model 2 (goodness-of fit, P1 = 0.930, P2 = 0.105; AUROC1 = 0.879 (95% CI 0.862–0.896), AUROC2 = 0.845 (95% CI 0.813–0.877), respectively). Thus, our study demonstrated AKD was independently associated with increased 90-day mortality in hospitalized AKI patients. A new prediction model system was able to predict AKD following AKI and 90-day prognosis of AKD patients to identify high-risk patients.

scholarly journals Acute kidney injury in SARS-CoV2-related pneumonia ICU patients: a retrospective multicenter study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Guillaume Geri ◽  
Michael Darmon ◽  
Lara Zafrani ◽  
Muriel Fartoukh ◽  
Guillaume Voiriot ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Cox Model ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Icu Patients ◽  
Increased Risk ◽  
Stage 1

Abstract Background While acute kidney injury (AKI) is frequent in severe SARS-CoV2-related pneumonia ICU patients, few data are still available about its risk factors. Methods Retrospective observational study performed in four university affiliated hospitals in Paris. AKI was defined according to the KIDGO guidelines. Factors associated with AKI were picked up using multivariable mixed-effects logistic regression. Independent risk factors of day 28 mortality were assessed using Cox model. Results 379 patients (median age 62 [53,69], 77% of male) were included. Half of the patients had AKI (n = 195, 52%) including 58 patients (15%) with AKI stage 1, 44 patients (12%) with AKI stage 2, and 93 patients (25% with AKI stage 3). Chronic kidney disease (OR 7.41; 95% CI 2.98–18.4), need for invasive mechanical ventilation at day 1 (OR 4.83; 95% CI 2.26–10.3), need for vasopressors at day 1 (OR 2.1; 95% CI 1.05–4.21) were associated with increased risk of AKI. Day 28 mortality in the cohort was 26.4% and was higher in patients with AKI (37.4 vs. 14.7%, P < 0.001). Neither AKI (HR 1.35; 95% CI 0.78–2.32) nor AKI stage were associated with mortality (HR [95% CI] for stage 1, 2 and 3 when compared to no AKI of, respectively, 1.02 [0.49–2.10], 1.73 [0.81–3.68] and 1.42 [0.78–2.58]). Conclusion In this large cohort of SARS-CoV2-related pneumonia patients admitted to the ICU, AKI was frequent, mostly driven by preexisting chronic kidney disease and life sustaining therapies, with unclear adjusted relationship with day 28 outcome.

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